Diuretics and ACE Inhibitors Overview

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Questions and Answers

What adverse effect is associated with hydrochlorothiazide that requires monitoring for patient safety?

Weight gain

Hypertension

Tachycardia

Hypokalemia (correct)

Which of the following nursing implications is critical for patients taking diuretics?

Monitor intake and output (correct)

Administer in the evening

Encourage high salt intake

Limit fluid intake

Which adverse effect is specific to ACE inhibitors like captopril?

Cough (correct)

Bradycardia

Hypoglycemia

Urinary retention

What distinguishes the mechanism of action of diuretics from that of ACE inhibitors?

Diuretics inhibit Na/Cl channels, while ACE inhibitors block angiotensin conversion. Signup and view all the answers

What is a primary concern regarding the use of potassium-rich foods in patients taking captopril?

Potential for hyperkalemia Signup and view all the answers

Which of the following is an important consideration for patients with a sulfa allergy when taking diuretics?

They may need to avoid diuretics altogether. Signup and view all the answers

What is a critical side effect to inform a patient about when starting treatment with captopril?

Dry cough Signup and view all the answers

Why is orthostatic hypotension a significant concern for patients on hydrochlorothiazide?

It increases the risk of falls. Signup and view all the answers

What effect does captopril primarily have on bradykinin?

Prolongs its vasodilating effects. Signup and view all the answers

What is a significant contraindication for women of childbearing age with renal insufficiency related to medication management?

They must be on birth control. Signup and view all the answers

Which of the following is an adverse effect associated with ARBs?

Angioedema Signup and view all the answers

Which nursing implication is crucial when administering calcium channel blockers?

Educate on possible food/drug interactions. Signup and view all the answers

What should not be co-administered with ARBs?

ACE inhibitors Signup and view all the answers

What mechanism of action do ARBs utilize?

Block angiotensin II at receptor sites. Signup and view all the answers

Which of the following adverse effects is associated with dihydropyridines like amlodipine?

Peripheral or pulmonary edema Signup and view all the answers

What is a contraindication for the use of ARBs in pregnant women?

BBWarning existence Signup and view all the answers

Which antihypertensive class primarily works by inhibiting the influx of calcium ions?

Calcium channel blockers Signup and view all the answers

What is a potential consequence of taking an ACE inhibitor with an ARB?

Increased risk of hypotension. Signup and view all the answers

What is the primary advantage of using ARBs over ACE inhibitors?

No cough side effect Signup and view all the answers

What is a significant adverse effect of beta-adrenergic blockers?

Bradycardia Signup and view all the answers

Which of the following is a potential nursing implication for using sodium nitroprusside?

Continuous BP monitoring required Signup and view all the answers

What effect do non-dihydropyridines like verapamil and diltiazem primarily have on cardiac function?

Decrease heart rate Signup and view all the answers

Which medication might increase the plasma concentration of certain drugs due to CYP3A4 interactions?

Grapefruit juice Signup and view all the answers

For which condition are beta-adrenergic blockers specifically not recommended as initial therapy?

Heart failure Signup and view all the answers

What effect do direct acting vasodilators primarily have?

Decrease peripheral vascular resistance Signup and view all the answers

Patients on beta-adrenergic blockers should be monitored for which potential complication?

Heart block Signup and view all the answers

What is a key contraindication for using non-selective beta-blockers?

Asthma Signup and view all the answers

What symptom may indicate an overdose of beta-adrenergic blockers?

Bradycardia Signup and view all the answers

Which of the following is a recommended method to relieve edema in patients taking certain medications?

Elevate extremity Signup and view all the answers

Study Notes

Diuretics

Prototype: Hydrochlorothiazide
Mechanism of Action: Inhibits sodium/chloride channel in distal convoluted tubule, increases renal excretion of sodium and chloride, increases urine output, decreases blood volume, vasodilation
Adverse Effects: Orthostatic hypotension, dizziness, hypokalemia, hyponatremia, hypercalcemia, hyperuricemia, hyperglycemia
Nursing Implications: Advantages include low cost, reduced morbidity and mortality, and few side effects. Useful for patients with predisposition to kidney stones and osteopenia. Take in the morning or during the day to prevent sleep disturbances. Monitor input/output (I/O), weight, and laboratory values (labs). Advise patients to change positions slowly to avoid dizziness. Encourage potassium-rich foods and discourage salt substitutes. Avoid in patients with sulfa allergy or gout.

Angiotensin-Converting Enzyme (ACE) Inhibitors

Prototype: Captopril
Mechanism of Action: Blocks enzyme that converts angiotensin I to angiotensin II, inhibits breakdown of bradykinin (prolongs vasodilating effects)
Adverse Effects: Cough, angioedema, pregnancy contraindicated, taste change, orthostatic hypotension, fatigue, rash, proteinuria, renal insufficiency, increased potassium, lower blood pressure (BP) and leukopenia
Nursing Implications: Monitor labs and electrolytes. Consult the healthcare provider (HCP) if a cough becomes bothersome. Avoid salt substitutes containing potassium or foods rich in potassium. Black Box Warning (BBW): Do not get pregnant! Women of childbearing age should be on birth control. Avoid taking with angiotensin II receptor blockers (ARBs).

Angiotensin II Receptor Blockers (ARBs)

Prototype: Losartan
Mechanism of Action: Blocks angiotensin II at various receptor sites, prevents effects of vasoconstriction and aldosterone secretion
Adverse Effects: Advantages include no cough and rare angioedema. BBW: Pregnancy
Nursing Implications: Do not take with ACE inhibitors.

Calcium Channel Blockers

Dihydropyridines:
- Prototype: Amlodipine
- Mechanism of Action: Inhibits influx of calcium ions in smooth muscles of blood vessels
- Adverse Effects: Cytochrome P450 (CYP3A4) metabolism, edema (peripheral or pulmonary), flushing, reflex tachycardia
- Nursing Implications: Educate patients on possible food and drug interactions. CYP3A4 inducers (e.g., St. John's wort) decrease effectiveness. CYP3A4 inhibitors (e.g., grapefruit juice) increase plasma concentration. Educate on relieving edema: compression socks, encourage walking, elevate the extremity.
Non-Dihydropyridines:
- Prototype: Verapamil, Diltiazem
- Mechanism of Action: Inhibits influx of calcium ions in cardiac muscles and pacemaker cells
- Adverse Effects: CYP3A4 metabolism, bradycardia, arrhythmias (rare), heart block, heart failure (HF)
- Nursing Implications: Use with caution in patients with bradycardia, HF, and those taking beta blockers. More effect on heart function but less effect on vasodilation.

Beta-Adrenergic Blockers

Prototype: Propranolol
Mechanism of Action: Not initial therapy unless specifically indicated, blocks epinephrine and norepinephrine at beta-adrenergic receptors (decreases heart rate and contractility). Types: Selective (metoprolol, atenolol, esmolol) and Non-Selective (propranolol, timolol)
Adverse Effects: BBW: Abrupt discontinuation can cause exacerbation of angina, dysrhythmias, and myocardial infarction (MI) in patients with coronary artery disease (CAD). Bradycardia and heart block. Exacerbates HF. Asthma and chronic obstructive pulmonary disease (COPD) use with caution. Tapering is essential. Masks symptoms of hypoglycemia (no tremors or tachycardia). Lowers blood pressure. Orthostatic hypotension. Circulation may be impaired. Signs and symptoms of overdose: Bradycardia, heart block, hypotension, and mental status change.
Nursing Implications: Monitor heart rate and rhythm, weight, I/O, edema, and lung sounds. Do not stop abruptly. Avoid non-selective beta blockers in patients with asthma or COPD. Educate diabetic patients to check blood glucose (BG) regularly. Dangle and go slowly from sitting to standing. Caution in patients with peripheral vascular disease (PVD). Can cause erectile dysfunction (ED).

Direct Acting Vasodilator

Prototype: Sodium Nitroprusside
Mechanism of Action: Directly relaxes smooth muscle in blood vessels, resulting in dilation and decreased peripheral vascular resistance
Adverse Effects: Nausea, agitation, muscle twitching
Nursing Implications: Given intravenously (IV) and requires continuous blood pressure (BP) monitoring. Rapid onset and short duration of action. Converts to thiocyanate in the liver: Can cause cyanide toxicity (coma, dilated pupils, pink color). Monitor thiocyanate levels in labs. Antidote: Amyl nitrate inhalation.

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Description

This quiz covers the essential aspects of diuretics, focusing on Hydrochlorothiazide, and ACE inhibitors like Captopril. It discusses their mechanisms of action, potential adverse effects, and important nursing implications for patient care. Test your knowledge and understanding of these crucial pharmacological agents used in managing various medical conditions.